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A major hurdle in pediatric formulation development is the lack of safety and toxicity data on some of the commonly used excipients. While the maximum oral safe dose for several kinds of excipients is known in the adult population, the doses in pediatric patients, including preterm neonates, are not established yet due to the lack of evidence-based data. This paper consists of four parts: (1) country-specific perspectives in different parts of the world (current state, challenges in excipients, and ongoing efforts) for ensuring the use of safe excipients, (2) comparing and contrasting the country-specific perspectives, (3) past and ongoing collaborative efforts, and (4) future perspectives on excipients for pediatric formulation. The regulatory process for pharmaceutical excipients has been developed. However, there are gaps between each region where a lack of information and an insufficient regulation process was found. Ongoing efforts include raising issues on excipient exposure, building a region-specific database, and improving excipient regulation; however, there is a lack of evidence-based information on safety for the pediatric population. More progress on clear safety limits, quantitative information on excipients of concern in the pediatric population, and international harmonization of excipients' regulatory processes for the pediatric population are required. [ABSTRACT FROM AUTHOR]

Background/objectives: Sedentary behavior (SB), defined as sitting (nonexercising), reclining, and lying down (posture), or by low energy expenditure, is a public health risk independent to physical activity. The objective of this systematic literature review was to synthesize the available evidence on amount of SB reported by and measured in older adults. Data source: Studies published between 1981 and 2014 were identified from electronic databases and manual searching. Large-scale population studies/surveys reporting the amount of SB (objective/ subjective) in older adults aged ≥ 60 years of age were included. Appraisal and synthesis was completed using MOOSE guidelines. Results: 349,698 adults aged ≥ 60 within 22 studies (10 countries and 1 EU-wide) were included. Objective measurement of SB shows that older adults spend an average of 9.4 hr a day sedentary, equating to 65-80% of their waking day. Self-report of SB is lower, with average weighted self-reports being 5.3 hr daily. Within specific domains of SB, older adults report 3.3 hr in leisure sitting time and 3.3 hr watching TV. There is an association with more time spent in SB as age advances and a trend for older men to spend more time in SB than women. Conclusion/ implications: Time spent sedentary ranges from 5.3-9.4 hr per waking day in older adults. With recent studies suggesting a link between SB, health, and well-being, independent of physical activity, this is an area important for successful aging. Limitations: Different methodologies of measurement and different reporting methods of SB made synthesis difficult. Estimated SB time from self-report is half of that measured objectively; suggesting that most self-report surveys of SB will vastly underestimate the actual time spent in SB. [ABSTRACT FROM AUTHOR]

This paper examines US, Japanese, and European political economy approaches to China, and their effect on US-Japan and US-EU relationships. Great powers with a greater security concern in dealing with another major country care more about power while those with less of a concern are preoccupied with calculations for wealth. China's rise and its actions have posed a far greater security challenge to the United States and Japan and are driving the two countries closer together. The political economy game involving China reveals a dominant welfare motive among the advanced market economies. The ambition to transform China politically has diminished. China's integration into the global market makes a relative gains approach difficult to implement. Globalization simply limits the ability of a state to follow a politics-in-command approach in the absence of actual military conflict, which explains why the political economy approaches of the United States, Europe, and Japan are not that different in the scheme of things. China's own grand strategy to reach out to the world to outflank the US-Japan alliance has also contributed to a divergent European policy toward China although there are severe limitations to Beijing's ability to drive a wedge between the United States and Europe. [ABSTRACT FROM AUTHOR]

Foreign policy strategy toward China has always been a priority for the Japanese, In the 1980s, Japan strengthened its engagement with China, offering Official Development Assistance (ODA), and cooperating with the United States and Western Europe to promote the growth of a Chinese market economy that would contrast with the Soviet system. The 1989 massacre of protesters in Tiananmen Square drew international criticism, however, damaging China's status abroad. Following the Taiwan Strait Crisis between 1995 and 1996, the conceptualization of China as a threat began to gain even more traction in Japan. This paper argues that the perception of China as a threat has led the Japanese to incorporate a "hedging" strategy into its policy of engagement with China. This hedging" strategy has included strengthening japan's alliance with the United States, and building a multilayered security framework that gives China incentives to conform its external behavior to "international standards." The author further warns that a mixed strategy could be ineffective, and recommends that Japan attract the cooperation of China and the world through long-term investments in institutions and technology, traditional areas of Japanese strength. [ABSTRACT FROM AUTHOR]

Abstract: Visions about the establishment of a lunar base and development of the Moon for scientific, technical and commercial ends have been on the political agenda since the beginning of the Space Age. In the past few years a number of spacefaring nations, including the USA, European states through ESA, Japan, India, China and Russia have proposed missions directed at the robotic and human exploration and development of the Moon. This paper argues that an important factor in advancing these missions lies in a partnership between the pubic, governmental sector and the private sector. The paper analyzes the dynamics of this partnership as applied to the case of the US Vision for Space Exploration. The results of the analysis suggest that public–private partnerships directed at lunar development and commerce depend on how government reduces risks for the private sector. The risks identified and discussed herein include political and legal risks, technological risks, and financial and market risks. [Copyright &y& Elsevier]

This paper first discusses the Common European Framework of Reference Languages: Learning, teaching and assessment CEFR 2001 and the revisions to this framework in CEFR 2018. It then looks at the Frameworks of Reference for English Language Education in Thailand, Japan, Vietnam, Malaysia and China which are based on CEFR. The main purpose of this study is to highlight the potential issues that need to be addressed including international forms of assessment such as TOEFL, IELTS, TOEIC and how the rating in CEFR can be compared to the scores obtained in these high-stake standardized tests of language proficiency. The indications are that using the same proficiency scales as the basis for rating scale criteria may lead to perceived equivalence but does not necessarily lead to a greater comparability of shared criteria. The implications from a number of studies are that different tests use similar criteria that are based on the same descriptors, but the comparability is only assumed.

This paper investigates the place of pedagogy in language-in-education policy through an analysis of how the macro-level of government policy interacts with the micro-level of local educational practice. It argues that pedagogy is typically considered a micro-level activity and policy frequently devolves decision-making about pedagogy to micro-level agents. For this reason, pedagogy is often invisible in policy texts. Pedagogy becomes a concern for macro-level policy when micro-level practice is constructed as being a problem and policy seeks to intervene to reform practice. However, whether pedagogy is explicitly discussed in policy, it remains nonetheless relevant for policy implementation and ultimately for the success of policy change. The silence about pedagogy in policy texts may render invisible the capacity for pedagogical change at the micro-level and the capabilities and resources needed to effect change. The paper will examine these issues through an investigation of a series of language policy contexts in which pedagogy is either an explicit concern or it remains implicit.

The "images" which have commonly distinguished Brussels' relations with Beijing (starting from the 1990s) and Tokyo (since the Cold War years) appear to actually be the result of the concurrence of events and of structuring factors that denoted trade problems on the surface, or dysfunctions generated by the systemic variable. Nonetheless, in this paper I try to explain that these problems are fundamentally based on a much more complex and inherent divergence of two universes of values and different political cultures. Zhao Tingyang's theory on "relation rationality" and the Japanese ethical notion of "relational coexistence" (linked to Watsuji Tetsuro) may help to inscribe and construct modern historical relations between China and Japan towards Europe into a narrative by bringing - in Carol Gluck's words - "the outside in". Finally, I analyze the relationship between the three actors in the light of the systemic changes occurred after the end of the bipolar system and especially following the 9/11 terrorist attacks, trying to highlight the potential of their political dialogue. [ABSTRACT FROM AUTHOR]

This paper aims to identify the current state of knowledge management (KM) diffusion in LIS schools. In terms of content, we have identified two principal approaches to the perception of KM in the LIS community: an active approach, seeing KM as an opportunity for the LIS community to change; and a passive approach, seeing KM merely as a topic of information management with a new label. Our research analyzed study programs at 145 LIS schools and in 188 LIS study programs in the United States, Canada, Europe (in particular, Russia), Australia, India, South Africa, China, Japan, Singapore, and Brazil and observed the inclusion or non-inclusion of KM courses in those programs. We employ a narrower approach to defining a KM course as being one having the term "knowledge management" in its name. The findings indicate that KM courses are integrated in one-third of the LIS study programs analyzed, and in schools with an information science focus this figure can rise to around 45%. Given the importance of this area and various views regarding KM diffusion in LIS schools, we recommend that those who have already implemented a KM course in their LIS programs create an informal community of practice (CoP) on KM implementation in LIS schools and build an open database of lessons learned from such integration, thereby capturing and sharing this crucial knowledge in a single place.

Major demographic changes around the world. Disproportionate sovereign debt. A shift from North America, Western Europe, and Japan to emerging economies as centers of growth. Unprecedented levels of market risk and volatility. The structure of the global economy is undergoing significant changes. Michael Oyster, managing principal of Fund Evaluation Group, explored this topic with Sam DeRosa-Farag, principal of the investment team at Morgan Creek Capital Management, and Stephen Wood, chief market strategist at Russell Investments.

Many countries are making strategic plans to replace conventional vehicles (CVs) with electric vehicles (EVs), with the motivation to curb the growth of atmospheric CO2 concentration. While previous publications have mainly employed social-economic based models to predict CO2 emission trends from vehicles over the years, they do not account for the dynamics of engine and motor efficiency under different driving conditions. Therefore, this study utilized an experimentally validated vehicle dynamic model to simulate the consumption of gasoline and electricity for CVs and EVs, respectively, under eight driving cycles for different countries/regions. The CO2 emissions of CVs and EVs through 2040 were then calculated, based on the assumptions of the improvement of engine efficiency and composition of power supply chain over the years. Results reveal that, assuming that the current projections and assumptions remain valid, China would have the highest CO2 emission for EVs, followed by Japan, world average and the EU, mainly determined by the share of fossil fuels in the power grid. As for the influence of road conditions, the CO2 emission of CVs was found to be always higher than that of EVs for all countries/regions over the years. The difference is around 10–20% under highway conditions, and as high as 50–60% in crowded urban driving conditions. [ABSTRACT FROM AUTHOR]

The purpose of this research is to quantitatively compare everyday situational experience around the world. Local collaborators recruited 5,447 members of college communities in 20 countries, who provided data via a Web site in 14 languages. Using the 89 items of the Riverside Situational Q-sort (RSQ), participants described the situation they experienced the previous evening at 7:00 p.m. Correlations among the average situational profiles of each country ranged from r = .73 to r = .95; the typical situation was described as largely pleasant. Most similar were the United States/Canada; least similar were South Korea/Denmark. Japan had the most homogenous situational experience; South Korea, the least. The 15 RSQ items varying the most across countries described relatively negative aspects of situational experience; the 15 least varying items were more positive. Further analyses correlated RSQ items with national scores on six value dimensions, the Big Five traits, economic output, and population. Individualism, Neuroticism, Openness, and Gross Domestic Product yielded more significant correlations than expected by chance. Psychological research traditionally has paid more attention to the assessment of persons than of situations, a discrepancy that extends to cross-cultural psychology. The present study demonstrates how cultures vary in situational experience in psychologically meaningful ways. [ABSTRACT FROM AUTHOR]

The Association of Southeast Asian Nations (ASEAN) has led the way in constructing the East Asian region with China, Japan, and South Korea, and an inter-regional entity with the European Union (EU)--known as the Asia-Europe Meeting (ASEM). The initial aims were security and trade. Recently, however, higher education has been brought into these regionalising processes, largely as a response to the globalising of neoliberalism. The paper argues that regions are social, economic, and political constructions shaped by both material forces and cultural factors. It emphasises the importance of the latter and explains three mechanisms at work: "harmonisation" to build intra-ASEAN higher education cooperation; "socialisation" to create the ASEAN+3 region; and "mutual learning" to engage with the EU in shaping an "ASEM Education Area". These mechanisms influence the ways in which regional actors form new conceptions of self and other, negotiate norms, and (re)construct their identities and interests, thus creating new forms of cooperation and community. Particularly, "mutual learning" generates the outcome of a deeper negotiation for an equal partnership between the "Asia" and the "Europe" in ASEM. Hence, higher education regionalism emerges as a way to reposition Southeast Asia.

With the advent of mass higher education and the consequent absorption of significant national resources, both public and private, it is inevitable that universities are increasingly expected to meet a range of societal needs. They are expected to "connect" with society at large. In this paper, we argue that connectivity is best integrated with research, teaching and scholarship and should not be relegated to a "third stream". We compare degrees of connectivity of 50 national systems of higher education using ten indicators, making a distinction between domestic and international connectivity. The strongest finding is that smaller countries exhibit the highest level of international connectivity. The higher education systems in countries with large absolute numbers of researchers such as the USA, China and Japan are relatively self-contained compared with countries such as Ireland, Switzerland and Singapore. Another finding is the relative insularity of the education sector in Eastern Europe, including the Russian Federation. When differences in levels of economic development are allowed for, among lower-income countries South Africa stands out as having a well-connected higher education sector.

Abstract: Several types of reduced activation ferritic/martensitic (RAFM) steel have been developed over the past 30years in China, Europe, India, Japan, Russia and the USA for application in ITER test blanket modules (TBMs) and future fusion DEMO and power reactors. The progress has been particularly important during the past few years with evaluation of mechanical properties of these steels before and after irradiation and in contact with different cooling media. This paper presents recent RAFM steel results obtained in ITER partner countries in relation to different TBM and DEMO options. [Copyright &y& Elsevier]

BackgroundIn this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study.MethodIn 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions.ResultsThere was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p < 0.001), even with covariate adjustments for age and sex.ConclusionsThe pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC. [ABSTRACT FROM PUBLISHER]

This article develops data on the history of wages and prices in Beijing, Canton, and Suzhou/Shanghai in China from the eighteenth century to the twentieth, and compares them with leading cities in Europe, Japan, and India in terms of nominal wages, the cost of living, and the standard of living. In the eighteenth century, the real income of building workers in Asia was similar to that of workers in the backward parts of Europe but far behind that in the leading economies in north-western Europe. Real wages stagnated in China in the eighteenth and early nineteenth centuries and rose slowly in the late nineteenth and early twentieth, with little cumulative change for 200 years. The income disparities of the early twentieth century were due to long-run stagnation in China combined with industrialization in Japan and Europe. [ABSTRACT FROM AUTHOR]

The author argues that India must restructure its foreign and security policies within the framework of a multipolar world, in which China has become the second largest economy, while the economies of U.S., Europe and Japan have stagnated. The key factors to a new Indian foreign policy are hinged on the presence of an unstable neighborhood, an assertive China and a divided domestic politics. The author also believes that India must use its economic, cultural, military and diplomatic profiles to highlights its place in the international arena.

This article provides an international perspective on learning technology developments, with emphasis on the special challenges of designing distance learning technologies (DLT) in the developing countries of Asia. A commentary on the current achievements and problems of DLT designers is provided, based on the authors' recent study tour of distance education (DE) initiatives in 11 Asian countries: Bhutan, Cambodia, Hong Kong, India, Indonesia, Laos, Mongolia, Pakistan, the Philippines, Thailand and Vietnam. The authors compare these initiatives with others they observed in their previous visits to DE institutions in North America and Europe, China and Japan. The prospects for collaboration among DLT projects and research initiatives are discussed and the emergence of a 'Pandora's box' of educational possibilities is described--innovative, economical, and occasionally troubling in the challenges it provides to accepted DE practice. [ABSTRACT FROM AUTHOR]

Waste classification is to reduce solid waste and its associated environmental pollution. This paper applied bibliometrics to assess publications related to classification technology of domestic waste from 2000 to 2019. A total of 466 publications were retrieved. The results showed the number of citations and papers increased rapidly. The major publication type regarding waste classification technology is article and English is the primary language for academic communication. The research is multidisciplinary and interdisciplinary, and its research directions are mainly divided into "Engineering," "Environmental Sciences Economics," and "Chemistry." It was identified that Waste Management (85) published most of papers in this topic. Meanwhile, China (93) contributed the most of publications, followed by the USA (42), France (40), Japan (36), and Italy (28). European countries are in the leading position in the study of garbage classification technology. Plastics and waste metals were the existing focus of waste classification technology, and waste identification and classification has become an important classification method. In addition, we also summarized the current mainstream technology progress and possible research challenges.

Satellite observations show that the rapid urbanization and emergence of megacities with 10 million or more residents have raised PM2.5 concentrations across the globe during the past few decades. This study examines PM2.5 dynamics for the 33 cities included on the UN list of megacities published in 2018. These megacities were classified into densely (>1500 residents per km 2 ), moderately (300-1500 residents per km 2 ) and sparsely (<300 residents per km 2 ) populated areas to examine the effect of human population density on PM2.5 concentrations in these areas during the period 1998-2016. We found that: (1) the higher population density areas experienced higher PM2.5 concentrations; and (2) the megacities with high PM2.5 concentrations in these areas had higher concentrations than those in the moderately and sparsely populated areas of other megacities as well. The numbers of residents experiencing poor air quality is substantial: approximately 452 and 163 million experienced average annual PM2.5 levels exceeding 10 and 35 μg/m 3 , respectively in 2016. We also examined PM2.5 trends during the past 18 years and predict that high PM2.5 levels will likely continue in many of these megacities in the future without substantial changes in their economies and/or pollution abatement practices. There will be more megacities in the highest PM2.5 pollution class and the number of megacities in the lowest PM2.5 pollution class will likely not change. Finally, we analyzed how the PM2.5 pollution burden varies geographically and ranked the 33 megacities in terms of PM2.5 pollution in 2016. The most polluted regions are China, India, and South Asia and the least polluted regions are Europe and Japan. None of the 33 megacities currently fall in the WHO's PM2.5 attainment class (<10 μg/m 3 ) while 9 megacities fall into the PM2.5 non-attainment class (>35 μg/m 3 ). In 2016, the least polluted megacity was New York and most polluted megacity was Delhi whose average annual PM2.5 concentration of 110 μg/m 3 is nearly three times the WHO's non-attainment threshold., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Vespa velutina nigrithorax is an invasive alien organism that has raised concerns in all beekeeping communities of invaded countries including the Republic of Korea, European countries and Japan. Known also as the yellow-legged hornet (or the 'Asian hornet'), it is native to northern India, eastern Nepal, Bhutan and the People's Republic of China. Given its climatic and biological characteristics and the effects of climate change, some coastal areas of North America, Argentina, South Africa, Australia and New Zealand are also susceptible to invasion. Vespa velutina nigrithorax notably affects managed honey-bee colonies by predation on foragers and causing a reduction in the collection of food resources. Being a generalist predator, the yellow-legged hornet also preys on other managed and wild pollinators, and therefore its impacts are not limited to the beekeeping sector but also represent a biodiversity concern. The purpose of this paper is to provide an assessment of V. v. nigrithorax against the four criteria established in Chapter 1.2. of the World Organisation for Animal Health (OIE) Terrestrial Animal Health Code for the inclusion of a disease, infection or infestation in the OIE list. The work was requested by the OIE Scientific Commission for Animal Diseases and presented to this Commission and to the OIE Terrestrial Animal Health Standards Commission in September 2017. Owing to the lack of effective measures to prevent its spread, the fact that its legal situation in some countries is under the mandate of environmental authorities rather than Veterinary Services, and because it is not considered a disease or parasite, V. v. nigrithorax is not currently being proposed for inclusion in the OIE list. At the end of the text, the statements from the two commissions are included and discussed.

Background and Aims: Miscanthus, a C4 perennial grass native to East Asia, is a promising biomass crop. Miscanthus sacchariflorus has a broad geographic range, is used to produce paper in China and is one of the parents (along with Miscanthus sinensis) of the important biomass species Miscanthus × giganteus. The largest study of M. sacchariflorus population genetics to date is reported here., Methods: Collections included 764 individuals across East Asia. Samples were genotyped with 34 605 single nucleotide polymorphisms (SNPs) derived from restriction site-associated DNA sequencing (RAD-seq) and ten plastid microsatellites, and were subjected to ploidy analysis by flow cytometry., Key Results: Six major genetic groups within M. sacchariflorus were identified using SNP data: three diploid groups, comprising Yangtze (M. sacchariflorus ssp. lutarioriparius), N China and Korea/NE China/Russia; and three tetraploid groups, comprising N China/Korea/Russia, S Japan and N Japan. Miscanthus sacchariflorus ssp. lutarioriparius was derived from the N China group, with a substantial bottleneck. Japanese and mainland tetraploids originated from independent polyploidization events. Hybrids between diploid M. sacchariflorus and M. sinensis were identified in Korea, but without introgression into either parent species. In contrast, tetraploid M. sacchariflorus in southern Japan and Korea exhibited substantial hybridization and introgression with local diploid M. sinensis., Conclusions: Genetic data indicated that the land now under the Yellow Sea was a centre of diversity for M. sacchariflorus during the last glacial maximum, followed by a series of migrations as the climate became warmer and wetter. Overall, M. sacchariflorus has greater genetic diversity than M. sinensis, suggesting that breeding and selection within M. sacchariflorus will be important for the development of improved M. × giganteus. Ornamental M. sacchariflorus genotypes in Europe and North America represent a very narrow portion of the species' genetic diversity, and thus do not well represent the species as a whole., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: This article describes a bibliometric review of the scientific production, geographical distribution, collaboration, impact, and subject area focus of pneumonia research indexed on the Web of Science over a 15-year period., Methods: We searched the Web of Science database using the Medical Subject Heading (MeSH) of "Pneumonia" from January 1, 2001 to December 31, 2015. The only document types we studied were original articles and reviews, analyzing descriptive indicators by five-year periods and the scientific production by country, adjusting for population, economic, and research-related parameters., Results: A total of 22,694 references were retrieved. The number of publications increased steadily over time, from 981 publications in 2001 to 1977 in 2015 (R 2  = 0.956). The most productive country was the USA (38.49%), followed by the UK (7.18%) and Japan (5.46%). Research production from China increased by more than 1000%. By geographical area, North America (42.08%) and Europe (40.79%) were most dominant. Scientific production in low- and middle-income countries more than tripled, although their overall contribution to the field remained limited (< 15%). Overall, 18.8% of papers were the result of an international collaboration, although this proportion was much higher in sub-Saharan Africa (46.08%) and South Asia (23.43%). According to the specific MeSH terms used, articles focused mainly on "Pneumonia, Bacterial" (19.99%), followed by "Pneumonia, Pneumococcal" (7.02%) and "Pneumonia, Ventilator-Associated" (6.79%)., Conclusions: Pneumonia research increased steadily over the 15-year study period, with Europe and North America leading scientific production. About a fifth of all papers reflected international collaborations, and these were most evident in papers from sub-Saharan Africa and South Asia.

The history of international spread of Chinese acupuncture and moxibustion is divided into three sta ges in this paper, and the spreading characteristics are analyzed. The first stage is approximately from the 6th century to the end of the 15th century, during which acupuncture and moxibustion were spread to neighboring countries by personnel exchanges; the spread towards Korean peninsula, Japan and Vietnam was considered the most successful communication. The second stage lasts from the beginning of 16th century to 1970. At the early time of this stage, the employees of the Dutch East Indian Company introduced acupuncture and moxibustion to European countries through Indonesia and Japan, leading to a short and small fashion; also the United States and Australia were involved. At the late time of this stage, by medical aid teams dispatched by China government, acupuncture and moxibustion were introduced to African countries. The third stage starts from 1971. With the establishment of Sino-US diplomatic relations as an opportunity, acupuncture and moxibustion were being spread rapidly to the world through radio, TV and internet. So far it has been introduced to more than 140 countries and areas. Performing serious studies on the spreading characteristics of three stages will promote the international communication of acupuncture and moxibustion, by which the world will have a better understanding onthe broad and profound traditional cultures of China.

Multiple antibiotic resistance threatens current treatment for community-acquired pneumonia (CAP). This paper presents a summary of resistance data for Streptococcus pneumoniae (6,223 isolates), Haemophilus influenzae (4,016) and Moraxella catarrhalis (1,263) collected from 153 centers throughout Japan, China, UK, Germany, Spain, France, Italy, Brazil and USA. Antiobiotics tested were: beta-lactams (penicillin, ampicillin, co-amoxiclav, cefuroxime, and ceftriaxone), macrolides (azithromycin and clarithromycin), sulphonamide (trimethoprim-sulfamethoxazole), glycopeptide (vancomycin) and fluoroquinolone (levofloxacin). S. pneumoniae with reduced susceptibility to penicillin were predominant in France, Spain and Japan (54-65%), ,beta-lactamase-producing H. influenzae most common in the USA, France and Spain (>25%) and most M. catarrhalis produced beta-lactamase irrespective of origin. S. pneumoniae susceptibility to azithromycin and clarithromycin varied widely. Levofloxacin was active against almost all isolates in all countries and none was resistant to vancomycin. Because of increasing resistance to older drugs, the newer fluoroquinolones have a role in the therapy of CAP and other respiratory infections, although surveillance studies must continue.

Since research into dyslexic difficulties has been conducted predominately among those whose first language is English, assumptions may have been made about the nature of dyslexia which are dependent on the complex features of that language. This paper considers first a sample of 'transparent' languages without those particular inconsistencies of phoneme-grapheme correspondence: they seem to produce fewer children with problems but nevertheless do present some different inconsistencies of their own. Another 'opaque' language (French) is shown to present different problems from English. Finally, the paper considers what the difficulties for dyslexics could be in countries with languages having a morphemic script, e.g. Chinese and Japanese kanji. It is suggested that more research is needed into the ways in which particular languages generate particular dyslexic manifestations.

This paper reviews evidence from two overviews of prospective, observational studies of the association of diastolic blood pressure (DBP) with the risk of stroke in populations from the US and Europe and populations from China and Japan. The Western overview included seven studies involving a total of 405,511 individuals. During a mean follow-up period of 11 years, 843 strokes were observed. The Eastern overview included 18 cohorts involving a total of 124,774 participants. During a mean follow-up duration of 9 years, 1,798 strokes were observed. The shape of the association between usual DBP and the risk of stroke was similar in Western and Eastern populations, but in Eastern populations the size of the association was about 50% steeper than that in Western populations. This may be due, at least in part, to cerebral haemorrhage comprising a greater proportion of total stroke in Eastern populations. This finding, together with the high stroke rates in many Eastern Asian populations, suggests that the potential benefits of blood pressure lowering may be greater in Eastern Asia.

This paper represents a historical analysis of the results achieved by esophageal cancer surgery over the last three decades, as they appear in the literature of the years 1954-1985, and in our own experience between 1965 and 1985, with the aim of assessing the evolution of operative mortality and long-term survival. In a review of 4930 resections reported in western literature, mean values of perioperative mortality went down from 30% to 9%, while the five-year survival increased from 8% to 19%. Similar changes were evident in Japanese and Chinese literature where the survival rose from 9% to 23% in unscreened populations and up to 90% in early cancers. In our experience, dividing the series in two decades (1965-74 and 1975-85), the overall perioperative mortality changed from 28% to 13%. The actuarial survival for the two periods was 8% vs 18% at 5 years, with a median survival of 9 and 18 months. A greater difference was evident for N0 patients where the survival rose from 15% to 35% at 5 years, with a median survival of 15 vs 38 months.

The main aim of the Medical Humanics course, as well as that of this university, is to educate students so that they will continue philosophizing for themselves throughout their lives. Dr. Hisayoshi Omodaka, the founder of Japanese Medical Humanics (or Igaku Gairon), claimed that this discipline must be the philosophy of medicine. Medical Humanics should be the philosophy for physicians, researchers and all other health-related professionals. This philosophy is different from the philosophy which is taught independently to freshmen in the university. Thus the philosophy of medicine should embody those concrete materials which are harvested directly from the hot spots of medical practice. This paper is based on the author's series of lectures in medical humanics with the title: "Man and Medicine", given between October and December of 1982 to the 5th-year undergraduates. In this series the author attempted to express his own views, along with the philosophical thinking of many great physicians and thinkers, so far as they are reflected in the mirror of the history of medicine. The outline is as follows: (1) Usefulness of the history of medicine for medical students. (2) Origin of medicine and the occult sciences. (3) Western classic medicine: from Hippocrates to the Renaissance. (4) Chinese classic medicine. (5) Brief sketch of Japanese medicine: from ancient to Meiji period. There is a general tendency among both medical students and teachers to make little of the history of medicine. However, as William Hazlitt wrote in his poem, "By despising all that has preceded us, we teach others to despise ourselves".